Tracing the source of contaminated lettuce can be hard because it's often repackaged by middlemen, said Sarah Sorscher, deputy director of regulatory affairs at the Center for Science in the Public Interest. As a result, people across the entire United States are advised to not eat any type of romaine lettuce.

Restaurants and retailers have also been urged to stop selling this type of lettuce.

The E. coli strain identified appears similar to one linked to leafy greens a year ago.

"FDA and states are working to trace back romaine lettuce that ill people ate in the current outbreak". This new outbreak has thus far resulted in 13 hospitalizations and zero deaths.

"It's still early in this investigation and work remains to pinpoint the source of contamination that contributed to this outbreak", Food and Drug Administration Commissioner Scott Gottlieb stated on November 20.

Children under the age of 5 years, adults older than 65, and people with weakened immune systems are more likely than others to develop severe illness.

"That's why we think it's critical to get this information out", Gottlieb said.

Restaurants are also advised to avoid serving romaine lettuce in any form, be it full leaves, chopped, or otherwise. About 128,000 people end up in the hospital and 3,000 die annually.

Report your illness to the health department. This investigation is ongoing and the advice will be updated as more information is available. "Investigators are using evidence collected in both outbreaks to help identify the possible cause of the contamination in these events".

In all 50 states, the CDC has the capacity to do genomic testing on samples from infected patients (such as blood samples).

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